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Commission based marketing mechanism in pvt hospitals

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PRIVATE hospitals and diagnostic centres have turned into "excessive profit-seeking businesses" due to a lack of government monitoring, says a new Transparency International Bangladesh study. Over the course of time, these health care facilities have established a "commission-based marketing mechanism" where everyone -- from physicians to receptionists -- benefits from the widespread malpractice, it says.

The research for the study was conducted on 66 private hospitals and 50 diagnostic centres across the country between January and December last year. Of those, 26 were in Dhaka Metropolitan areas. According to the study report, 63.3 percent of the households of the country take medical services from the private sector.

Citing Health Bulletin-2015 of the Directorate General of Health Services (DGHS), the study also says 60.3 percent of the doctors are involved in the private health care services. The number of privately-owned registered health care facilities increased to 15,698 in 2017 from just 33 in 1982.

Physicians, health assistants, family planning employees, rural doctors, pharmacy owners, midwives, receptionists, rickshaw-pullers, and middlemen are involved in the "commission based" marketing mechanism". With verbal agreements, they receive from "15 to 50 percent commission" from the diagnostic centres. For each Caesarian section patient, these beneficiaries get Tk 500 to Tk 5,000 as commission, the study says.

In most of the cases, the patients, despite paying excessive fees, do not get proper health care services in return. A privately-owned organisation will be profit-oriented, but there has to be some standards. These standards are not being maintained. There may be some rationale for cost increases compared to public-run hospitals but when costs are over 300-400 percent more there is cause to worry. Most of these hospitals don't even have proper facilities for storing reagents used for tests or proper waste disposal facilities. In such situations how can they charge such high fees?

Regulatory authorities like the DGHS and the Bangladesh Medical and Dental Council (BMDC) must increase their organisational capacity at central and field level to have better inspection capabilities. So-called hospitals which don't even have clearance from the Department of the Environment should not exist at all. Steps must be taken to close down the unregistered institutions. Steps must also be taken to ensure that doctors don't indulge in unethical practices to obtain more patients. When the lives of people are dependent upon the commissions which people get then it becomes very difficult to predict what sort of treatment they would actually get. This must be stopped.

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